To investigate the treatment methods and effects of old fractures of the middle part of the face. Methods The clinical data of 63 patients with old fractures of the middle part of the face admitted to our hospital from May 2002 to October 2010 were retrospectively analyzed, and different surgical approaches and treatment methods were used according to different fracture types. The results showed that most of the patients achieved a large degree of improvement in appearance and function without serious complications. Conclusion The appropriate treatment for old fractures of the middle part of the face can restore the function and shape of the middle part of the face. In recent years, the occurrence of maxillofacial fractures has been increasing year by year due to the frequent occurrence of traffic accidents, work-related injuries and other accidents. Patients with midface fractures are often associated with cranial, visceral or extremity injuries, and often lose the opportunity for early treatment and become old fractures. The old fracture of the middle part of the face causes serious functional and morphological impairment. Their surgical treatment is a challenge in the management of oral and maxillofacial trauma. With the development of internal jaw fixation materials and the introduction of orthognathic surgical approaches, the treatment of old mid-facial fractures has improved greatly, but is still unsatisfactory. We admitted 63 patients with old fractures of the middle part of the face from May 2002 to October 2010, with a post-injury period of 3-10 weeks. The patients had symptoms such as restricted mouth opening, facial deformity, occlusal disorders, diplopia, and infraorbital nerve compression. Preoperative 3D CT reconstruction of the facial bones was performed to determine the fracture site and the plan of surgery. In patients without mouth opening restriction, preoperative oral dentition models were taken and the occlusal relationship was pieced together using the model surgery method. For patients who needed to cut bone blocks to reconstruct the occlusal relationship, positioning occlusal plates were made according to the reconstructed occlusal relationship. All patients were anesthetized with a combination of intravenous and inhalation anesthesia via nasotracheal intubation, and the bimaxillary arch splints were ligated after anesthesia. A one- or bilateral scalp coronal incision + lower lid margin incision + maxillary vestibular sulcus incision was used to fully expose the periorbital area, zygomatic bone, zygomatic arch, nasal bone, and maxilla, and the original fracture break was dissected (chiseling the original fracture line, bluntly separating the fibrous adhesions of the surrounding tissues, removing the hyperplastic bone scabs and cutting the sharp bone tips of the fracture line), from the less severely injured side to the more severely injured side, under direct view from the top to the bottom. Lefort I osteotomies were performed to reposition the fracture ends. In order to ensure a good occlusal relationship, intermaxillary ligation and small/miniature titanium nails (Xi’an Zhongbang or Medicon) were used to fix the fractured ends on the lateral orbital wall, zygomatic arch, infraorbital rim, zygomatic-alveolar ridge, lateral pear-shaped foramen, and nasal floor to restore the height of the nasofrontal pillar, zygomatic-alveolar pillar, pterygomaxillary pillar, and the prominence of the zygomatic arch, nasal arch, and upper and lower alveolar arches, and to restore the inherent width, height, and prominence of the midface. For patients with bone defects, half-layer cranial bone, iliac bone, allogeneic decalcified bone and other bone substitutes such as hydroxyapatite or titanium can be implanted, and the inner canthal ligament can be repositioned and fixed, and orbital wall bone grafting and orbital content retraction can be performed at the same time to correct the sunken eye deformity. After surgery, the patient was given intermaxillary elastic traction for 1 to 4 weeks depending on the recovery of the bite. After follow-up from 3 months to 8 years after surgery, 57 of 63 patients had satisfactory recovery of facial appearance, good recovery of occlusal relationship, and opening of the mouth more than two cross fingers; 5 patients had basically satisfactory recovery of facial appearance and occlusal relationship. 3 of 5 patients with diplopia had disappearance of diplopia, 2 had improvement after prescription of glasses, and 11 of 13 patients with infraorbital nerve compression had normal recovery. 6 of 8 patients with orbital entropion had recurrence, 2 had postoperative infection and delayed healing, and 2 had postoperative infection. Two cases had postoperative infection and delayed healing, and two cases had implant rejection reaction. There were no cases of serious complications.